Reducing the rural tobacco burden through state and academic partnerships

Exposure to secondhand smoke (SHS) increases the risk for coronary heart disease by 25-30%. Declines in heart attacks following comprehensive smoking bans have been reported worldwide. The West Virginia State Health Department (SHD) has long promoted the development of clean indoor air regulations (CIAR) at the local level. WV statutes authorize local boards of health to promote and maintain “clean and safe air.”

This presentation showcases how a long-standing partnership between a SHD and a PRC has lessened the impact of tobacco use on a rural state.

Tobacco control efforts in WV were boosted by the 1998 Master Settlement Agreement, which enabled the SHD to create a network of 10 regional tobacco prevention coordinators whose role includes establishing county-based coalitions to promote the adoption of CIAR. Each coordinator serves 5-6 largely rural counties. WV's SHD approached the PRC for assistance with evaluating their tobacco prevention and cessation initiatives, including the network, which initially focused on process measures. Early CIARs were modest in scope, providing limited protection from SHS.

The PRC's role evolved into the provision of technical assistance as well as evaluation services. The PRC helped strengthen local coalitions' understanding of their opportunities and the critical steps to follow to increase the likelihood that local boards of health (BOHs) in largely rural areas adopt comprehensive CIARs. Additionally, the PRC and the Kanawha County Health Department studied Acute Coronary Syndrome admissions before and after a comprehensive CIAR was adopted in the County. The study found a 37% decline in hospital admissions between Jan. 2000 and Sept. 2008; the decline was significant among nonsmokers, people without diabetes, and women.

Today, 22 of WV's 55 counties have eliminated smoking in all workplaces, including bars, restaurants, and gaming establishments. In the last 5 years, 13 counties have adopted comprehensive CIAR to protect all workers from SHS exposure. 790,177 West Virginians (43% of the population) now live in smoke-free counties. Furthermore, 72% of adults ban smoking in their homes.

The science and practice communities can collectively work together to inform local policy makers of the benefits of clean indoor air regulations in order to effect positive change in our rural communities. Keys to success include patience, cooperation, and following proven guidelines such as Best Practices.